Avatar Therapy:
A New Battle for the Tree of Life

Rufus May
24
412

In the film Avatar, scientists are keen to exploit the moon planet Pandora which is inhabited by 10-foot-tall blue humanoids called Na’vi.  To do so they create Na’vi human hybrids called “Avatars” which are controlled from afar by genetically matched humans. When the scientists decide to destroy the eco-system of the planet to gain access to valuable minerals, war breaks out between the humans and the Na’vi. At this point the main character, Jake, who operates an Avatar, has to choose whose side he is on.  Eventually Jake’s life is saved and transformed by the Tree of Souls, which the humans are trying to destroy.

Why are Avatars in the news again? The latest innovation from psychiatric research is using computer-generated avatars to help people who hear aggressive voices. With headlines like ‘Avatars help to silence schizophrenic voices’ it’s caught the media’s attention worldwide. It’s a bit of a publicity coup for the researchers as stories on treatment for schizophrenia usually don’t take up much copy.  But this story has the feel of a science fiction movie.  For a start it’s got a scientist, Prof Julian Leff leading it, who has definitely got the ‘Back to the future’ wild white hair look. But what takes centre stage in the press articles are computer-generated images of voices, looking a little on the sinister side. Let’s hope the real scientists don’t make the same mistake as they do in the Avatar film and – instead of just trying to get rid of the voices – listen to a bit of local knowledge. Who knows? If therapists pretend to be aggressive voices that mellow when stood up to maybe, as in the film, they will become more sympathetic to beings they don’t understand.

The Avatar therapy has been hailed by many as ground-breaking, a fantastic break-through, an alternative to drug treatment where the drugs aren’t working. On the other hand the biological believers (people who think schizophrenia is a biological disease that needs biological interventions) look on sceptically; pointing to the small scale of the research. It must be a bit of a shock to many conventional schizophrenia researchers because it’s actually a psychological approach that is getting attention; not a gene discovery or a wonder drug.  Meanwhile those in the hearing voices movement (including me) also ask questions; suspicious of scientists – posing as voices – getting a lot of attention for a snazzy-looking role-play. So what is all the fuss about?

This was a very small pilot study that created computer generated images -avatars – designed to look like each person’s voice. The therapist sat in another room and  said aggressive things via the avatar and the person was encouraged to stand up to their voice and gradually the avatar voice became more friendly.  In a BBC News health article by Lorna Stewart, Julian Leff said:

“I encourage the patient, saying; ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’… The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”

The research started off with 26 voice hearers but by the end of the six 30 minute sessions only 16 had completed the course. For the people who completed the course the results seem promising.  For nearly all the last 16 there was a reduction in frequency and severity of the voice hearing and three of the participants stopped hearing voices altogether.  It’s reported that that the reason 10 did not complete the course is because they were bullied by the voices into stopping.

O.K., I need to admit something here; I am confused! Why? Because I personally have had a very mixed reaction to this Avatar therapy news that includes fear, jealousy, excitement and hope.

I am jealous of the attention this research is getting! Not only did Avatar therapy get good publicity but there is 1.3 million pounds being put into the follow-up research (by the Wellcome Trust), this time with 142 participants.  Why has this research generated such interest? Usually society does not want to know about therapies for voice hearing.  In our culture there is a massive fear of hearing voices other people can’t hear.  These are the demons of our nightmares, and psychiatry’s attempt to deal with them with sedating drugs and disease terminology does not seemed to have helped increase our understanding.

I wonder if the invisibility of voices makes them more scary and, by putting a face to the experience, people are able to be more interested.  In Hearing Voices groups we have done something similar; not with computer-generated images but with finger puppets of people’s voices.  For example; you can make constructive voices finger puppets and get them to dialogue with the aggressive ones.

But finger puppets don’t have the same science fiction appeal, so I won’t get my hopes up for a million-pound research project into finger puppet therapy.  But maybe this is the beginning of more open-minded approaches in the mainstream… Maybe I should get off my ‘holier than thou’ horse and offer to collaborate. I guess I would love for Hearing Voices groups, and the dialogic approaches I and others use, to start getting such interest.

I am worried at how the researchers and the media equate aggressive voice-hearing with schizophrenia. There are huge problems with the diagnosis of schizophrenia.  It lacks scientific validity and presupposes long-term chronicity and biological abnormality.  A growing proportion of psychologists in the U.K. no longer use the term schizophrenia because it disguises the unique and complex psychological confusion people are experiencing.  The diagnosis itself creates a sense of hopelessness and a lack of curiosity about the meaning of people’s experiences.

Yet the media ignores these problems, as do funders of therapy research.  There is growing evidence that hostile and controlling voices are linked to traumatic childhood experience, so it is worrying that researchers at UCL are not making these links.  I appreciate the dilemmas researchers are in; they want to do innovative research but they are framed by the parameters of the dominant ideology.  Perhaps they feel that if they do not use concepts like ‘treatment-resistant schizophrenia’, or mention trauma, they won’t get the funding.

At the same time I am excited because the researchers use the term ‘dialogue’ quite a bit. Now I think the type of dialogue Julian Leff seems to be encouraging is a little simplistic and hostile, i.e.; ‘be nice to me or go away’.  But its a start.  I teach people to be assertive but non-aggressive to the voices. Once the person is able to stand up to the voice we also try to get a sense of the emotional life of the voice itself.  I have found once the voice has the experience of having its feelings and needs listened to it very often starts to become more constructive. I feel encouraged that Julian Leff and his colleagues seem to be encouraging this constructive relationship to emerge by acting it out in the role-play they do via the avatar.

In the media coverage of this there is a lot of talk of ‘controlling voices’, ‘silencing voices’ and ‘taming them’. One of the researcher talks about ‘shifting’ them. Much is being made of the fact that 3 of the participants’ voices stopped altogether.  In my experience some voices are fairly simple replays of abusive characters from the past. I have found that if the person learns to confront the memories – e.g.; through confronting the original person in a role-play – these voices do disappear. I think this is probably what happened for 3 of the participants.

However many voices appear to be more complicated parts of consciousness, with their own personalities, and in my view we should not try to get rid of them.  Rather we should seek to set boundaries with them (as the study does) but also, if they persist, it is often very helpful to dialogue with them.

This means dialoguing not with an avatar but directly with the voice.  We call this approach ‘voice dialogue’ or ‘talking with voices’.  Therapists or supporters can help the person learn new ways to to relate to the voice; being assertive, but also friendly and compassionate.

We have this macho approach in the West to conquer, and control; I think it’s misguided.  Aggressive voices seem to be messengers about emotional conflicts in the person’s life. We can see them as separated-off parts of the person that are carrying painful emotions.  While we want to empower the person to be assertive we also need to acknowledge the voices’ painful feelings.  This is not something that can be done in 6 brief sessions.  So I am worried if Avatar therapy is seen as a quick fix. Ideally I want us to help all people who hear voices so I am interested in the 10 people who dropped out. Confronting terrorising parts of your mind is really tricky and you need a lot of support. I hope the researchers become interested in creating safe-enough spaces that allow more people to try to learn to change the power relationship with their voices.

Aggressive voices are often protecting terrifying memories the person has dissociated from. So when the person learns to confront the voices they then often need to confront difficult emotions and memories.  We need to give people the opportunity to do this integrative work and very often it needs significant time and space.  It’s well worth doing because it can take people out of a dis-empowered  and passive role in their lives. However; resources are needed that are not just ‘brief therapy interventions’ if we want to make the psychological benefits sustainable.

In some ways the Avatar therapy reminds me of the Wizard of Oz. Initially, the Wizard seems to be all powerful, but his huge head turns out to be an illusion conjured by this little ordinary man. By acting out voices using avatars or puppets we can make the experience less scary. I think it’s a great beginning to learning to face our fears and our voices.  I guess I would like the principle of role-playing voices (or other difficult relationships) to be something that is not seen as a sophisticated therapy, that only highly trained professionals can do. After all; children do it with their teddy bears.

In the film Avatar, the indigenous Na’vi turn out to have a wisdom about life that humans can learn from.  At present the Avatar therapy’s main aim seems to be to make the person more assertive and to try to control the voices.  My hope is that it develops to not only strengthening the person but also learning from the voices.  In the film Jake is struggling to breathe without a respirator on the planet Pandora and by connecting with the Tree of Souls he is transformed so he can breathe. Previously humans were trying to destroy the Tree of Souls to exploit the planet’s resources. Aggressive voices seem to have their social origins in an atmosphere of violence and denial.

I think if we connect with the energy of voices non-judgementally we can participate in a healing process that is transformative for the people involved.  People can reclaim their fighting spirit and have buried truths acknowledged. I have found that supporting people in this integrative and respectful approach to voices is a powerful and humanising process for me, as well. It puts me in touch with my unheard and buried energies.  So it’s important to move away from therapy warfare – against voices and each others’ different approaches – and come back to a non-aggressive approach to our experiences because that is where the life energy truly is.

I think Avatar therapy is encouraging because it is trying to simulate and understand voice hearing. Where voices endure I would like the researchers to strengthen their intention to support dialogue with the voices (or beings) people are living with.  I would also like the researchers at University College London to perhaps be clearer on the philosophy behind their approach.  Are they trying to silence voices or are they trying to learn from the voice hearing experience?
Links:

http://www.bbc.co.uk/news/health-22691718

http://www.bbc.co.uk/news/health-22720248

http://rufusmay.com/index.php?option=com_content&task=view&id=94&Itemid=9

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Rufus May
Rufus May is a psychologist in Bradford, England. He believes everybody can flourish with the right support network. His work is part of an emancipatory movement that includes the hearing voices movement, community development approaches and other self-help and holistic health movements.

24 COMMENTS

  1. I don’t view this as a ‘massive breakthrough’, I guess I view it like any other ‘intervention’, in that it will have a place for some people but isn’t and shouldn’t be a set up as ‘The alternative’ to medication/CBT or for the “treatment resistant”.
    It’s just one more thing which some people who wish to attempt to eradicate their voices simply by becoming more assertive and saying ‘go away’ might want to try. For those people who wish that [and we can’t deny those individuals] then let them have a go. I guess my nagging fear is that as with any psychological intervention it still comes down to the skill, attitude and humility of the therapist and psychological therapy of any type has the potential to be very dangerous in the wrong hands.

    I support the use of Voice Dialogue, everything has a place, I couldn’t personally get on with it because I couldn’t get my voices to speak to another person on demand but that doesn’t detract from its value for others, I know it’s a good tool for some people.

    For voice hearers who wish to understand more about the meaning of their voices; origins, evolution and context, then changing the relationship between them and their voices with assertion alone Avatar Therapy will probably be unsatisfying.

    Not all voices require a physical form for some voice hearers, and for those with visual voices who already have form, using an avatar could be as dangerous as flooding, akin to putting someone with a phobia of cats into a roomful of them.
    Some of my voices are visual [an animal] and as it is when I see one in print/on the TV I can at the worst run out screaming. How the hell would I cope with a talking avatar of the animal voices I most fear? I’d probably smash the screen [then the therapist].

    It wouldn’t work with tactile voices and it wouldn’t work with paranoia which can’t really be given a form as such.

    I did find it useful to make a recording of some of my voices using my voice and other people’s [with a script of the words/phrases] with fairly simple recording equipment. I would have liked to have gone further and had access to a recording studio for more specialised sound effects. The reason I found this useful is because I could play it to others and say ‘this is what it’s like’, and this was only one tiny sliver of a snapshot, not the full range.
    Every voice hearer I played it to said OMG that’s so realistic, as it shared similar qualities.
    This sort of thing I’d love to see funded – voice hearers wanting to record their voices having access to a studio to do so for recording for their own use [and with their permission for teaching].
    I’d call it the Voice Soundscape Project, I know I’ll never see it happen, but I can dream…

  2. I found the Avatar research a bit wierd too.

    Years ago I did a short art therapy course (three weekends) and jolly good it was too. These people seem to be doing with computers what I learnt to do with paper and crayon.

    1.3 million pounds is a lot of money for something which is essentially a way of trying to understand someone’s experience and then trying to find ways of helping them be less scared.

    There are lots of ways of doing that already.

    Can I have some money please? I’ve got a nice pack of crayons, some big bit of paper and a lot of time on my hands

  3. “O.K., I need to admit something here; I am confused! Why? Because I personally have had a very mixed reaction to this Avatar therapy news that includes fear, jealousy, excitement and hope.

    I am jealous of the attention this research is getting!”

    Seems to be the eternal problem of social politics and our competition for the survival resource of social recognition? Why do we “instinctively” react with caution and pessimism towards anything novel in the environment? Like the phenomena of hearing voices, are there unconscious mechanisms, beneath our taken for granted “psychological” perspective?

    Although, after the initial negative reaction, we do seem to approach with a more appropriate curiosity;

    “I think Avatar therapy is encouraging because it is trying to simulate and understand voice hearing. Where voices endure I would like the researchers to strengthen their intention to support dialogue with the voices (or beings) people are living with.”

    Avatar, is a particular favorite of mine, for its “existential” metaphors. It seems, at least to me, to ask existential questions about our current predicament, “hometree” representing our blind urge to dominate mother nature, and each other. Also, the looming catastrophe of climate change, and our human obligation to our ancestors, and their sacrifice towards the possibility of a golden age, so long prophesied.

    Perhaps we really are entering a time of resurrection, as we move beyond the denial of our evolved nature, and the reality of psychosis, as a function of human nature.

    Personally, I believe there are deeper aspects to the phenomena of hearing voices, which can be resolved with an exploration of internal function, beneath our “cognitive constructs” which so often distance the mind from the core nature of being, within the body. For example: are voices stimulated by a hyper-vigilance to “low-frequency” sounds in the background, which reflects our ancient fear of predators?

    A hyper-vigilance of the nervous systems, which professor Stephen Porges calls “neuroception.” http://www.frzee.com/neuroception.pdf

    Also, in the emerging science discipline of psychophysiology, the heart’s reciprocal connections with the brainstem, is bringing a more holistic perception of emotional reactivity, of which, hearing voices, may be seen on a continuum of physiological/psychological experience.

    Best wishes to all,

    David Bates.

  4. to me, although encouraging because it is not drug-based, this therapy seems like a dodge in a way– it avoids engaging directly with the voices! Why create an “avatar” and then have a doctor imitate the voice-hearing experience when we have real voices already in our heads talking to us! It makes no sense. They say that it will train you to stand up to the voices and expect them to back down, but this strikes me as so simplistic– just because a doctor imitated a voice backing down, does that mean my voices are going to? Voices don’t want to be dismissed, after all they are in my opinion whatever part of you was already on some level dismissed from your consciousness / identification with your own thoughts. So to suggest a second dismissal seems misguided. You can run but you can’t hide forever, as someone said in another thread here on MIA. Although it’s easy to see why people would want to just get rid of a voice that is aggressive, it seems like we need to encourage people to accept the voice as a player in their life and teach them to work with it, not expect it to go away and / or just “shut up.”

  5. 2 Questions here:

    How much money went into this cheezy CGI?

    Who is Paying for it?

    But then, I suppose it’s not really as stupid as it looks, considering:

    In San Francisco, which has a higher density of Astral Plane surfing Disease Mongerers than any other town in the US, they were paying the Chief Shrink $181,600 a year to deal with the ‘Symptoms’ of other peoples minds, and HE was overjoyed to tell the world that not Only was the most important part of his Professional life hieing himself off to Esalen to watch feature films for the ‘Mentally Ill’ but that he was Also a member in good standing of the “Illuminati”.

    This crowd has cheap CGI. The San Francisco treat watched The Wizard of Oz for (not with, but FOR, the ‘Mentally Ill’
    http://psychroaches.blogspot.com/2010/08/watching-wizard-of-oz-todays-bio.html

    They were also real big on a white wash of a mass murdering Communist Revolutionary named Che, and one about a Milllionaire Hollywood Drag Queen (Tootsie)

    http://psychroaches.blogspot.com/search/label/Illuminati%20Psychiatric%20Bio-Science

    And apparently, It Worked, because this Shrink and his fellow mental healthers got to be So good at making ‘Symptoms’ go away, that they extended their otherworldly powers to 2 Brick and Mortar Hospitals and Staffs and made Them disappear too.

    http://psychroaches.blogspot.com/search/label/SFMHB%2006%2F13%2F07

    There are days, when I look into Psych that I begin to feel like I’m looking at a freshly manured 400 acres of farm fields.

  6. It’s interesting to think of psychological conflicts as arising from unresolved social situations, which can impact the person as heard voices or through feelings that are sensations of the disharmonious situation. I like the idea of thinking through how to engage with the minds f the people involved in the disharmony to resolve the situation.

  7. Great article!

    Is it me or schizophrenia is a word that puts in the same basket different experiences?

    Anyhow… hearing voices:

    “In our culture there is a massive fear of hearing voices other people can’t hear.”

    Wow! People fear the voices the other people are listening. This is so strange!
    Whenever I say I have friends that are schizophrenics… “OMG! They are dangerous.” LOL

    I answer: “You know… go to a mental institution and speak to them. You’ll see that those who are left there without a single visit will be so happy to talk to you and receive a little attention. They need tenderness… that is all.”

    “However many voices appear to be more complicated parts of consciousness, with their own personalities, and in my view we should not try to get rid of them. Rather we should seek to set boundaries with them (as the study does) but also, if they persist, it is often very helpful to dialogue with them.”

    I also don’t think that the aim is to make them disappear. It is not like that.

    What amazes me me about how they always approach clinical trials, new therapies and so on is the total lack of emphasis on those who are being treated.

    They usually talk, and talk, and talk, and talk… and we keep confused because there is only one or two testimonies of participants.

    So they used 26 voice hearer. Where are their testimonies?
    Who are they?
    Where is the detailed report of the whole clinical trial?

    That’s why I’m always suspicious about what psychiatrists do: they speak too much about their work, their experiences, their thoughts, how wonderful their ideas are, how they want to help, how they, they, they… they… and they ad nauseam.

    I would love to know more about the finger puppets experience.
    Yes. It is not scientific appealing but I’m sure it is more interesting.

  8. ” It’s reported that that the reason 10 did not complete the course is because they were bullied by the voices into stopping.”

    What? There were 26 and 10 have left the experiment because they were bullied by the voices?

    I’m sorry but this is enough evidence for me to close the case and try another approach.

    They will try it again with 142 participants using 1.3 million pounds.

    I wonder how much will this therapy cost.
    “Be nice to me, go away…” OK!

    “Aggressive voices are often protecting terrifying memories the person has dissociated from. So when the person learns to confront the voices they then often need to confront difficult emotions and memories. We need to give people the opportunity to do this integrative work and very often it needs significant time and space. It’s well worth doing because it can take people out of a dis-empowered and passive role in their lives. However; resources are needed that are not just ‘brief therapy interventions’ if we want to make the psychological benefits sustainable.”

    Right Rufus, that’s the core of the problem.
    I wonder if “silencing the voices” is the real goal. It is not.
    What about visual hallucinations?

    Why don’t they make a virtual image of them?

    PLEASE: We need a “BACK TO TOP” button here in the end.

      • Joanna,

        You say “my visual voices”.
        I never had the guts to ask a person who hears voices about their experience because I don’t know how to do so.

        I fear entering a part of their intimacy that they don’t wanna share or that they just want to talk about it to those who experience it.

        One of the things I think strange about this avatar “therapy” is exactly putting an image to a experience that is, at least this is what I think, not related to anything visual.

        I remember when I did read Merleau-Ponty explaining that a patient said that her bed has a powder.

        They did put a powder on her bed and she said: “No! It is not the powder I see.”

        Another patient saw the silhouette of a person in front of his window. They did put a real silhouette: Same response: “No! It is not him.”

        At the explanation of the experiment:

        “… study that created computer generated images -avatars – designed to look like each person’s voice. The therapist sat in another room and said aggressive things via the avatar and the person was encouraged to stand up to their voice and gradually the avatar voice became more friendly. ”

        I still didn’t understand how it can help.

        I ask myself if when someone is hearing voices it would of any help if s/he could tell to a friend “I’m hearing this and that.”

        I don’t know but I would love to listen from those who hear voices what is the best way to help, how can others be part of their experience to make it more bearable.

        I believe that if a good campaign “Yes, some people hear voices and this is not that crazy, it is not contagious, they are not going to take over the world, they do not hear voices 24/7 and are human beings just…”… Hmmm… wishful thinking.

  9. I don’t mind you asking Ana.
    There are voices I hear, see and feel. The voices I hear don’t have a physical form I can see, other than two colour’s which can take any form i.e. street/shop sign. The voices I see obviously do have physical form, firstly externally to me i.e. an animal, and I can hear them [the sounds that animal makes] and feel them if attach themselves to my body or they attack me. Also internally where they can move under my skin or change the shape/size of body parts typically hands/face.
    In some ways the voices I hear are easier to manage than external visual ones which at the worst I can end up cutting off me or the internal visual ones which I can’t remove not unless I resorted to amputation. In saying the external visual ones have sometimes resulted in my needing surgical repair.
    I can’t see images of the visual one because when I see stills pictures or live images on the TV they can jump out at me resulting in ‘my’ animal voices attacking me.

    I would do this research differently, I would let people have access to sound studios to make recordings of their voices and to use however they see fit whether that’s part of therapy or not. Visual stuff might be harder in this respect.

    It can be useful to say to a friend or whoever ‘my voices are telling XYZ’ to ‘check out’ their words with what the person says, sometimes that helps, sometimes it doesn’t.
    A trusted friend has sometimes spoken to my voices and asked them to leave me alone for a while but without expecting them to speak to him. Sometimes that’s helpful.

    It’s a question of stock and evolving strategies but level of coping probably matters more than level of intrusion.
    I can’t accept my voices are emanating from me, but I accept their existence.

    • Joanna,

      ” …feel them if attach themselves to my body or they attack me. Also internally where they can move under my skin or change the shape/size of body parts typically hands/face.”

      Oh dear! It is not easy.
      I have already heard about the colors – ” two colour’s which can take any form i.e. street/shop sign…” – but only reading description of “symptoms” so too little was explained.

      Back in 1989 I took Halcion and I had some hallucinations as side effect.
      I don’t remember clearly but I felt things in my body too. I remember once when I felt as if my body was turning inside out.

      Very disturbing sensations and I got very scared. Psychiatrist said: “Will change the drug and it will go away.”

      Oh really? Some of the sensations took a long time to stop but I don’t know if I was really feeling them or if it was due to the traumatic experience.

      But now I don’t remember them. I believe I left them all at my psychoanalyst room. 🙂

      That is very good that talking to friends to try to help you works sometimes.

      How I wish that people was aware of what is going on in the mental health kingdom.

      “I can’t accept my voices are emanating from me, but I accept their existence.”

      Sure!

      Love,
      Ana

  10. In the article “Living Mindfully with Voices” Rufus May wrote what I think should be done:

    Changing how as Communities We Relate to Voices

    “At the moment as a society we do not accept voices. Instead we try to remove them from conscious awareness or control them through the use of sedating drugs and distraction strategies. A different approach is to support people who hear voices to become more present to their lives, if their voices are persistently seeking to be heard we need to find ways to listen to them from a place of grounded awareness. As friends and supporters of people who hear challenging voices we also need to learn to live mindfully with voices and listen to their deeper meanings. In this way of deep listening to people’s voices we are likely to learn truths about hidden parts of our communities and become wiser and more aware because of it. Therefore welcoming voices into our communities, whilst also setting boundaries with them is likely to lead to healthier ways to relate to ourselves and each other. One modern example of this welcoming approach is on the internet where some people who hear voices have given their voices Facebook and Twitter accounts and are interacting with people and other voices across the world (an example of this can be seen on the Intervoice Facebook group).”

    https://www.madinamerica.com/2013/04/living-mindfully-with-voices/

    Great article Rufus! Thank you for answering some of my doubts. 🙂

    Yes! Acceptance is of great help for many emotional issues.